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NPI Code Detail

MEDICARE: PATRICIA WOLLBERG

MEDICARE: PATRICIA WOLLBERG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1780131615
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA WOLLBERG
Provider Business Mailing Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number :
Provider Business Practice Location Address
First Line : 350 S 400 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-2905
Country : US
Telephone Number : 801-582-5534
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2016
Last Update Date : 09/08/2016

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Directions to “ PATRICIA WOLLBERG ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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